Department of cardiology, University of Oklahoma Health Sciences Center, Oklahoma, United States.
Department of cardiology, INTEGRIS Baptist Medical Center, Oklahoma, United States.
Hosp Pract (1995). 2022 Apr;50(2):93-101. doi: 10.1080/21548331.2021.1893065. Epub 2021 Apr 12.
The objectives of the study are to investigate the causes of diuretic resistance in patients with advanced congestive heart failure (CHF), since diuretics are the cornerstone of treatment of these patients. Several studies have shown that diuretic resistance in patients with advanced CHF is common, ranging from 25% to 50% in hospitalized patients.
In order to get a current perspective as to the magnitude of diuretic resistance in such patients, a focused Medline search of the English language literature was conducted between 2015 and 2020 using the search terms, CHF, diuretics, treatment, resistance, frequency, and 30 papers with pertinent information were selected.
The analysis of data from the selected papers demonstrated that diuretic resistance is common in hospitalized patients with advanced CHF and frequently associated with renal failure, which is secondary to CHF.
Diuretic resistance appears to be common in patients with advanced CHF and it is mostly due to decreased cardiac output, low blood pressure, decreased glomerular filtration rate, decreased filtration of sodium, and increased tubular reabsorption of sodium. Diuretic resistance in such patients can be overcome with the combination of loop diuretics with thiazide and thiazide-like diuretics, aldosterone antagonists, as well as other agents. The data from these studies in combination with collateral literature will be discussed in this review.
本研究旨在探讨晚期充血性心力衰竭（CHF）患者利尿剂抵抗的原因，因为利尿剂是这些患者治疗的基石。几项研究表明，晚期 CHF 患者的利尿剂抵抗很常见，住院患者的比例为 25%至 50%。
为了了解此类患者利尿剂抵抗的严重程度，我们在 2015 年至 2020 年间使用 CHF、利尿剂、治疗、抵抗、频率等英文术语对英文文献进行了重点 Medline 搜索，并选择了 30 篇具有相关信息的论文。
对所选论文数据的分析表明，晚期 CHF 住院患者中利尿剂抵抗很常见，常伴有心力衰竭引起的肾衰竭。
利尿剂抵抗在晚期 CHF 患者中似乎很常见，主要是由于心输出量降低、血压降低、肾小球滤过率降低、钠滤过减少和钠重吸收增加所致。联合使用袢利尿剂与噻嗪类和噻嗪样利尿剂、醛固酮拮抗剂以及其他药物可以克服此类患者的利尿剂抵抗。我们将结合相关文献对这些研究数据进行讨论。
